Osteoarthritis, Knee / Osteoarthritis, Hip, Pain, Postoperative
Conditions
Keywords
Total Knee Arthroplasty, TKA, Postoperative Pain, Pain Management, Analgesia, Nerve Block, Femoral Triangle Block, FTB, iPACK block, Local Infiltration Analgesia, Timed Up and Go Test, Straight Leg Raise, Periarticular Infiltration, Regional Anesthesia
Brief summary
This study aims to retrospectively compare two different multimodal analgesic techniques for pain management after total knee arthroplasty (TKA). The primary purpose is to evaluate whether a combination of two specific nerve blocks administered by an anesthesiologist (Femoral Triangle Block + iPACK block) resulted in superior postoperative pain control compared to a hybrid combination of a nerve block and a local infiltration administered by the surgeon (FTB + Periarticular Infiltration \[PAI\]). The hypothesis is that the FTB + iPACK combination is associated with a significant reduction in Numeric Rating Scale (NRS) pain scores with movement at 24 hours postoperatively. This is a retrospective, observational cohort study conducted at a single center, involving medical records of patients who underwent primary unilateral TKA. Data from patients who received either FTB + iPACK or FTB + PAI as part of their standard clinical care will be extracted and analyzed retrospectively.
Detailed description
Total knee arthroplasty (TKA) is a highly successful procedure for end-stage knee osteoarthritis but is associated with significant postoperative pain. Effective pain management is crucial for facilitating early rehabilitation and improving patient comfort. Modern pain management relies on multimodal, opioid-sparing protocols that often include motor-sparing regional anesthesia techniques like the femoral triangle block (FTB). While FTB provides excellent analgesia for the anterior part of the knee, pain originating from the posterior knee capsule remains a significant challenge. This posterior pain is commonly managed either by the surgeon through a diffuse periarticular infiltration (PAI) of a local anesthetic cocktail or by the anesthesiologist through a targeted, ultrasound-guided block of the posterior capsule known as the iPACK block. It is currently unclear whether a fully anesthesiologist-driven, neuroanatomically targeted approach (FTB + iPACK) offers superior clinical outcomes compared to a hybrid approach involving both the anesthesiologist and the surgeon (FTB + PAI). This retrospective study is designed to compare the clinical efficacy of these two advanced analgesic combinations by reviewing institutional patient registries. All included patients had previously received a standardized spinal anesthetic (3 mL of 0.5% heavy bupivacaine) followed by either of the regional analgesia protocols. The study evaluates postoperative pain control, measured primarily by Numeric Rating Scale (NRS) pain scores at 24 hours. Secondary outcomes include total rescue analgesic (tramadol) consumption, functional recovery (Timed Up and Go test and Straight Leg Raise test), and knee range of motion.
Interventions
None listed
Sponsors
Turgutlu State Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status II-III. * Scheduled for elective, primary, unilateral total knee arthroplasty for osteoarthritis. * Able to provide written informed consent.
Exclusion criteria
* Patient refusal to participate or contraindication to regional anesthesia. * Known allergy to any study medications (local anesthetics, NSAIDs, tramadol, morphine, paracetamol). * History of chronic opioid use (defined as daily use for \>3 months) * Pre-existing peripheral neuropathy in the operative limb. * Severe renal or hepatic insufficiency. * Cognitive impairment preventing the use of pain scales or questionnaires. * Revision or bilateral knee arthroplasty.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Score with Movement at 24 Hours | 24 and 48. hours postoperatively | Pain assessed via Numeric Rating Scale (NRS) during active movement (e.g., active knee flexion or straight leg raise). Scale: 0 (no pain) to 10 (worst pain imaginable). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Scores (Time-Course) | Assessed at 6, 12, and 24 hours postoperatively | Numeric Rating Scale (NRS) for pain (0-10) assessed at rest and with movement. |
| Time to First Rescue Analgesia | First 24 postoperative hours | Time (in minutes) from the end of surgery to the first patient request for rescue tramadol. |
| Time Up to Go Test | Assessed at 24 hours | The time taken (in seconds) for the participant to stand up from a standard armchair, walk a distance of 3 meters, turn, walk back to the chair, and sit down. Lower values indicate better functional mobility. |
| Straight Leg Raise | Postoperative 24. hour | Assessment of active quadriceps motor function. Defined as the participant's ability to actively lift the operated leg off the bed with the knee fully extended (straight). This will be assessed as a binary outcome (Success = Able to lift unassisted / Failure = Unable to lift). |
| Knee Range of Motion (ROM) | Baseline (Preoperative) and 24 hours postoperatively | Active knee flexion (in degrees) |
| Incidence of Adverse Events | First 48 hours. | Incidence of postoperative nausea/vomiting (PONV) and pruritus. |
Countries
Turkey (Türkiye)
Contacts
CONTACTCelil M Aslan, Medical Doctor
PRINCIPAL_INVESTIGATORAslan
Turgutlu State Hospital
Outcome results
None listed